- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.40 / $806.19 / $878.27
| Professional | | $664.40 | $806.19 | $878.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.34 / $851.75 / $1,194.23
| Professional | | $722.34 | $851.75 | $1,194.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $892.42 / $1,273.89 / $2,673.86
| Professional | | $892.42 | $1,273.89 | $2,673.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.36 / $1,398.52 / $2,618.46
| Professional | | $848.36 | $1,398.52 | $2,618.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.29 / $1,229.21 / $1,633.47
| Professional | | $631.29 | $1,229.21 | $1,633.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.57 / $394.43 / $502.00
| Professional | | $358.57 | $394.43 | $502.00 |